Provider Demographics
NPI:1790978070
Name:FRATT DENTAL CORPORATION
Entity Type:Organization
Organization Name:FRATT DENTAL CORPORATION
Other - Org Name:SANTA ANA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-428-1200
Mailing Address - Street 1:1631 N BRISTOL ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3347
Mailing Address - Country:US
Mailing Address - Phone:714-567-9255
Mailing Address - Fax:
Practice Address - Street 1:1631 N BRISTOL ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3347
Practice Address - Country:US
Practice Address - Phone:714-567-9255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRATT DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty